Transthoracic transdiaphragmatic approach in laparoscopic liver resection for hepatocellular carcinoma in a patient with severe obesity and history of deceased donor liver transplantation.
Asian J Endosc Surg
; 17(2): e13305, 2024 Apr.
Article
de En
| MEDLINE
| ID: mdl-38508162
ABSTRACT
BACKGROUND:
The transthoracic transdiaphragmatic approach (TTA) for hepatic tumors in laparoscopic liver resection (LLR) is not usually employed because the caudal approach via the abdominal cavity is the gold standard in LLRs. Here, we present a case of LLR via TTA for hepatocellular carcinoma (HCC) in a patient with severe obesity and a history of deceased donor liver transplantation (DDLT). MATERIALS AND SURGICAL TECHNIQUE The patient, a 64-year-old man with severe obesity and a history of DDLT, was referred to our hospital to undergo LLR for HCC located at the cranial side of segment IV. We decided to perform LLR via TTA because of concerns about the effect of severe adhesion, the difficulty of encircling the hepatoduodenal ligament, and the impact of severe obesity on the completion of LLR. Under general anesthesia with differential lung ventilation, we started to perform transthoracic ultrasonography to determine the diaphragmatic transection line. Then, we transected the diaphragm and revealed the tumor. We marked the parenchymal transection line with a 1-cm margin and then employed precoagulation of the hepatic parenchyma along the transection line. We performed parenchymal transection and clipped the responsible Glissonean pedicle at the bottom of the tumor. The diaphragm was closed using 3-0 nonabsorbable sutures with suture clips after the resected specimen was extracted.DISCUSSION:
We successfully performed LLR via TTA without hepatic inflow control. However, further studies are warranted to define the indications and recommendations for TTA in LLRs in the near future.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Obésité morbide
/
Transplantation hépatique
/
Laparoscopie
/
Carcinome hépatocellulaire
/
Tumeurs du foie
Limites:
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
Asian J Endosc Surg
Année:
2024
Type de document:
Article
Pays d'affiliation:
Japon